Risk Factors for Postoperative Intracranial Hemorrhage After Resection of Intracranial Tumor in 2259 Consecutive Patients

Wang, Chenghong; Niu, Xiaodong; Ren, Yanming; Lan, Zhigang; Zhang, Yuekang

doi:10.1016/j.wneu.2019.05.239

Cited by 16 publications

(19 citation statements)

References 17 publications

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“…For example, brain malignancies such as glioblastoma multiforme, which cause a pro-thrombotic state, put patients at an increased risk of VTE [13][14]. Risk factors for postoperative ICH include older age, larger tumor size, and increased operative time among others [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Comparative Cohort Study of Craniotomy and Prophylactic Enoxaparin Timing

Hallan¹,

Sciscent²,

Rizk³

2022

Cureus

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Introduction: Post-operative venous thromboembolism (VTE) prophylaxis is the standard of care after craniotomy, but there is debate over when to initiate VTE prophylaxis to decrease the morbidity and mortality experienced by these patients. This study aims to determine the effects of starting enoxaparin on day one vs. day three after craniotomy.Methods: We used a multi-institutional health research network (TriNetX) to gather data from the electronic medical records of patients who started enoxaparin one day after craniotomy (cohort 1) and patients who started it three days later (cohort 2). Our primary endpoint was mortality, with the secondary endpoints of deep venous thrombosis (DVT), additional craniotomy, pulmonary embolism (PE), myocardial infarction (MI), ischemic stroke (IS), intracerebral hemorrhage (ICH), ventilator and tracheostomy dependence, or percutaneous endoscopic gastrostomy (PEG) tube dependence. Patients were propensity score-matched for demographics, common comorbidities, and anticoagulant and antiplatelet use.Results: After propensity score matching, 1,554 patients were identified in each cohort. In cohort 1, 21.171% of patients were deceased after five years vs. 26.126% in cohort 2 (p= 0.0012; OR 0.759, 95% CI (0.643,0.897)). The 30-day survival was 94.521% vs. 93.049%, the 90-day survival was 90.200% vs. 87.335%, and the 365-day survival was 80.619 vs. 76.817%. Deep venous thrombosis occurred in 5.277% of cohort 1 and 7.851% of cohort 2 (p=0.0038, OR 0.654, 95% CI [0.49,0.873]). There was no increase in intracerebral hemorrhage in cohort 1. There were no statistically significant differences in subsequent craniotomy rates, PE, MI, IS, ventilator/tracheostomy, or PEG tube dependence. Conclusion:Starting enoxaparin on day one after craniotomy was associated with decreased mortality and DVTs, with no difference in rates of PE, MI, IS, tracheostomy/PEG dependence, or further craniotomy.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Comparative Cohort Study of Craniotomy and Prophylactic Enoxaparin Timing

Hallan¹,

Sciscent²,

Rizk³

2022

Cureus

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“…Nonsteroidal anti-inflammatory drugs have previously been avoided in cranial surgery patients because of fear of hemorrhagic complications. 38,75,78 This fear persists despite studies showing no difference in bleeding risk in adults 44 and children 11,61 undergoing cranial surgery. Similar investigations in orthopedics, 81 spinal surgery, 18 plastic surgery, 59 general surgery, 23 otolaryngology, 7 and other major surgeries 24 have affirmed the safety of postoperative NSAID use, as well as a meta-analysis of 27 studies with 2314 patients across a range of disciplines.…”

Section: Safety Of the Opioid-sparing Protocol In Cranial Surgerymentioning

confidence: 99%

“…Although NSAIDs have been effective in postoperative pain control in many types of surgery, 45,46 results in cranial surgery are less clear. 35,48,79 Nonsteroidal antiinflammatory drugs as a class are generally avoided because of the presumed risk of postoperative hemorrhagic complications which are often devastating in cranial surgery 38,78,75 . Some observational studies in these patients have suggested increased bleeding risks, 43,55 raising safety concerns for their use in adults 44 and children.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of an opioid-sparing analgesic protocol in pain control after less invasive cranial neurosurgery

Ahmad¹,

Khanna²,

Onyewuenyi³

et al. 2021

PR9

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Introduction: Opioid overuse in postoperative patients is a worrisome trend, and potential alternatives exist which warrant investigation. Nonsteroidal anti-inflammatory drug use in treating postoperative cranial surgery pain has been hampered by concern for inadequate pain control and increased risk of hemorrhagic complications. A safe and effective alternative to opioid-based pain management is critical to improving postoperative care. Objective: The objective of this retrospective study was to determine whether an NSAID-based opioid-sparing pain management protocol (OSP) is effective in analgesic control of less invasive cranial surgery patients at 6-, 12-, and 24-hour postoperatively. Secondary aims included investigating differences in hemorrhagic complications. Methods: Five hundred sixty-six consecutive patients who underwent cranial surgery before and after implementation of the celecoxib-based OSP were eligible. Propensity score matching was used to match patients in each cohort. Results: The opioid-sparing cohort had lower pain scores at 6 hours (3.45 vs 4.19, P 5 0.036), 12 hours (3.21 vs 4.00, P 5 0.006), and 24 hours (2.90 vs 3.59, P 5 0.010). Rates of postoperative hemorrhage were not significantly different (5% intervention vs 8% control, P 5 0.527). The opioid-sparing pain management protocol provided comparable or better pain control in the first 24 hours after less invasive cranial surgery. Hemorrhage rates did not change with the use of an NSAID-based OSP. Conclusion: An effective alternative to the current standard opioid-based pain management is feasible for less invasive cranial surgery. Determinations of hemorrhage risk and more complex cranial surgery will require larger prospective randomized trials.

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“…The incidence of POH specifically among patients with brain metastases is unclear. However, the incidence of POH after craniotomy for intracranial tumors in general has been reported to range from 1.8% to 2.1%, 8-10 and risk factors include older age, 9,10 higher blood international normalized ratio (INR), 9 larger tumor size, 9 and infratentorial location. 8…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for 30-day Postoperative Surgical Site Hematoma Requiring Evacuation After Resection of Brain Metastases

Zheng

Teo

Nga

et al. 2022

Preprint

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Objective: To identify the risk factors for a 30-day postoperative surgical site hematoma requiring evacuation (POH) after surgical resection of brain metastases. Methods: Patients who underwent surgical resection of brain metastases between 2011 and 2019 at our institution were included. Risk factors for a 30-day POH were identified using a multivariate logistic regression model. Results: A total of 158 patients were included in the analysis. The mean (SD) age of the study population was 59.3 (12.0) years, and 82 (53.2%) patients were female. The incidence of a 30-day POH was 8.2% (13 patients). There was no statistically significant association between the occurrence of a 30-day POH and overall mortality (p=0.100). On multivariate analysis, there was a statistically significant association between a 30-day POH and younger age (OR=0.91; 95% CI=0.83, 0.99; p=0.035), higher BMI (OR=1.61; 95% CI=1.16, 2.46; p=0.010), and blood type AB (OR=21.7; 95% CI=1.66, 522; p=0.031). On receiver operating characteristic analysis, a threshold BMI of 25.1 kg/m2 and threshold age of 57 gave the optimum balance of sensitivity and specificity in predicting the occurrence of a 30-day POH. Conclusions: Patients below 57 years old, who have a BMI of above 25, and/or have blood type AB were at higher risk of developing a 30-day POH after surgical resection of brain metastases. Additional care in intraoperative hemostasis and postoperative monitoring may be indicated among patients who have these risk factors.

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Risk Factors for Postoperative Intracranial Hemorrhage After Resection of Intracranial Tumor in 2259 Consecutive Patients

Cited by 16 publications

References 17 publications

A Retrospective Comparative Cohort Study of Craniotomy and Prophylactic Enoxaparin Timing

A Retrospective Comparative Cohort Study of Craniotomy and Prophylactic Enoxaparin Timing

Efficacy of an opioid-sparing analgesic protocol in pain control after less invasive cranial neurosurgery

Risk Factors for 30-day Postoperative Surgical Site Hematoma Requiring Evacuation After Resection of Brain Metastases

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